| NPI | 1366154817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS LOUCKS Office Manager 215-676-3070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2022-12-15 |